scholarly journals A method of reconstruction of female genitalia in girls with virilization

2014 ◽  
Vol 95 (3) ◽  
pp. 450-454 ◽  
Author(s):  
N R Akramov ◽  
A K Zakirov
Keyword(s):  
Surgical Treatment ◽  
Ambiguous Genitalia ◽  
Term Treatment ◽  
Urogenital Sinus ◽  
Basic Knowledge ◽  
Treatment Quality ◽  
Step Method ◽  
Self Identity ◽  
Long Term Treatment ◽  
One Step

The most common cause for female virilization is congenital adrenal hyperplasia. For anticipating the serious psychological distress related to ambiguous genitalia, these patients require plastic surgery. At present, two-step methods are preferred as more reliable. However, the surgical treatment in this case extends over several years, and can greatly affect patient’s psychosocial status. Based on the analysis of known surgical treatments, we proposed a one-step method of feminizing genitoplasty. The advantages of the proposed method allows one-step surgical treatment of girls with virilized genitalia at an earlier age, before the child reaches the period of sexual self-identity. This approach provides less psychosocial distress and reduces the number of interventions, maintaining the adequate sensitivity of the clitoris, providing moist and age-appropriate vaginal opening by using the preputium of the penis homolog and urogenital sinus mucosa at genitoplasty. The abovementioned advantages increases the surgical treatment quality and quality of life in girls with virilized genitalia. The method is reproducible by pediatric surgeons with basic knowledge of children’s anatomy. Yet, a lengthy follow-up is needed to assess the long-term treatment results.

Surgical treatment of diffuse toxic goiter in children. A review of the literature

2013 ◽  
Vol 4 (4) ◽  
pp. 69-76
Author(s):  
Alexander Vadimovich Gostimsky ◽  
Sergey Sergeevich Peredereev
Keyword(s):  
Surgical Treatment ◽  
Radioactive Iodine ◽  
Term Treatment ◽  
Graves Disease ◽  
Radioactive Iodine Therapy ◽  
Review Of The Literature ◽  
Large Size ◽  
Long Term Treatment ◽  
Toxic Goiter

Diffuse toxic goiter (DTG) is an autoimmune disease, to which there is a genetic predisposition. In children DTG is less common than in adults. Manifestation of graves‘ disease in childhood has a number of peculiarities. During the DTG in children is usually manifested thyrotoxicosis, requiring long-term treatment to achieve euthyroid, tendency to relapse and more frequently than adults, accompanied by ophthalmopathy and the large size of goiter. Diagnosis of graves‘ disease is based on the clinical picture of thyrotoxicosis, the existence of which is confirmed by the level of thyroid hormones and TSH in the blood. There are three types of treatment of patients DTG: medical, radioactive iodine therapy and surgery. There is no а single glance at the choice of the volume of operations in children.

scholarly journals Intersectoral Cost of Treating Pulmonary Non-Tuberculosis Mycobacterial Disease (NTM-PD) in Germany—A Change of Perspective in Disease Management

2019 ◽  
Vol 16 (20) ◽  
pp. 3795
Author(s):  
Roland Diel ◽  
Pontus Mertsch
Keyword(s):  
Disease Management ◽  
Outpatient Setting ◽  
Term Treatment ◽  
Treatment Quality ◽  
Periodic Case ◽  
Limited Information ◽  
Pilot Studies ◽  
Use Of Resources ◽  
Long Term Treatment ◽  
Hospitalization Costs

Background: In line with its increasing prevalence, pulmonary Mycobacterium avium complex (MAC) disease (MAC-PD) gives rise to substantial healthcare costs. However, there is only limited information on the costs of intersectoral reimbursement. Objectives: Inpatient and outpatient costs for diagnosing and treating pulmonary MAC-PD in Germany in accordance with standard international guidelines were calculated and their potential effects on MAC disease management in Germany were determined. Methods: Hospitalization costs were calculated by using the German diagnosis related group (G-DRG) browser, with and without inclusion of the diseases most often associated with M. avium. Separated by drug macrolide susceptibility and severity of MAC-PD, the direct medical costs of suitable therapies in the outpatient setting were determined by Monte-Carlo simulation, including all conceivable options. Results: According to our simulation, the weighted mean cost of outpatient treatment over 14 or 18 months, in either case followed by a post-treatment monitoring over 12 months, amounts to €8675.22 (95% confidence interval [CI] €8616.17 to €8734.27). Of that amount, the revenue for outpatient doctors´ services, dependent on treatment duration, is low, ranging between €894.79 (10.3%) and €979.42 (11.3%), accordingly. Mean drug costs for MAC-PD patients amount to €6130.25 [95% CI €6073.52 to €6186.98], i.e., more than two third (70.7%) of the total outpatient costs. In contrast, the non-surgical reimbursement for a hospital stay of up to 14 days is €3321.64. Hospital reimbursement does not increase in cases of complications (a higher number and/or challenging type of associated diseases), but it is fully paid even in cases that require as few as 2 days of hospitalization. Conclusion: The imbalance between well-rewarded hospital care and the low reimbursement for long-term treatment of MAC-PD outpatients may induce inappropriate disease management. In order to arrive at properly integrated care of MAC-PD patients in Germany, measures such as better incentives for physicians in the outpatient setting and a targeted use of resources in hospitals are required. Reimbursed, periodic case conferences between outpatient physicians and experts in hospitals as well as preventive short-term checks of MAC-PD patients in specialty clinics may promote cross-sector cooperation and improve overall treatment quality. Nationwide pilot studies are required to gain evidence on the effectiveness of the new approach.

scholarly journals Oral bisacodyl is effective and safe for short term treatment of chronic constipation

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Akanksha Vaishnav
Keyword(s):  
Surgical Treatment ◽  
Chronic Constipation ◽  
Clinical Decision ◽  
Term Treatment ◽  
Short Term ◽  
Short Term Treatment ◽  
Long Term Treatment ◽  
History Of ◽  
Non Surgical Treatment

A clinical decision report using: Kamm MA, Mueller-Lissner S, Wald A, Richter E, Swallow R, Gessner U. Oral bisacodyl is effective and well-tolerated in patients with chronic constipation. Clin Gastroenterol Hepatol. 2011;9(7):577-583. https://doi.org/10.1016/j.cgh.2011.03.026 to evaluate potential long term treatment with oral Bisacodyl in a patient with a history of chronic constipation and recent non-surgical treatment of ischemic colitis.

scholarly journals Results of treatment of congenital clubfoot after soft tissue release in children

2020 ◽  
pp. 81-85
Author(s):  
O. Holubenko ◽  
◽  
A. Levytskyi ◽  
O. Karabenyuk ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Surgical Techniques ◽  
Term Treatment ◽  
Soft Tissue Release ◽  
Idiopathic Clubfoot ◽  
Congenital Clubfoot ◽  
Cuboid Bone ◽  
Long Term Treatment ◽  
Plaster Casts

Topicality. Widespread use of the method of I. Ponseti allows to significantly reduce the number of reconstructive surgeries and/or reduce their volume. However, if presence the rigid, severe deformities that cannot be corrected with staged plaster casts, or recurrences, surgical treatment is advisable. The literature describes many surgical techniques, the main purpose of which is to reduce the frequency of postoperative complications. And at the same time find the most convenient access to eliminate contractures, further wound healing by primary tension with minimal formation of connective tissue elements. Objective: to reduce the incidences of complications in the surgical treatment of congenital clubfoot by using a modified surgical approach. Materials and methods. In the Department of Orthopedics and Traumatology of NCSH «OKHMATDYT» 57 children (72 feet) with a diagnosis of congenital clubfoot underwent surgical treatment using a modified Carroll approach for the period from January 2014 to September 2018. The mean age of patients was 3±0.4 years. 41 of them boys and 16 girls. Bilateral deformity was observed in 12 patients. 48 patients (58 feet) were underwent surgical treatment after initial treatment with staged plaster casts according to the method of I. Ponseti. Recurrences of deformity after surgery was observed in 9 patients (14 feet). Results. When assessing the immediate results during surgery in all patients, complete correction of foot deformity was achieved. No postoperative complications were noted. Long-term treatment results 2 years after surgery showed that good results were in 12 patients (21±9.53%), satisfactory in 39 (68.4±27.14%) and unsatisfactory in 6 (7±2.18%). Four patients with unsatisfactory results and residual manifestations of deformity in the form of passively corrected isolated adduction of the anterior foot, subsequently underwent surgery to transplant the anterior tibialis tendon to the lateral cuneiform bone. And 2 patients – wedge-shaped resection of the cuboid bone. Indication of which was not the possibility of passive correction of deformity. Conclusions. The comparative analysis of the obtained results and literature data testifies to the effectiveness of the proposed method of treatment of idiopathic clubfoot in children (using three approaches), as well as in the presence of residual deformity after conservative and surgical treatment. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. Key words: clubfoot, children, posteromedial release, surgical treatment.

scholarly journals Potentialities and Principles of Low-Invasive Osteosynthesis at Bones Fractures Treatment

2011 ◽  
Vol 18 (2) ◽  
pp. 5-11
Author(s):  
A F Lazarev ◽  
Eduard Ivanovich Solod ◽  
A A Lazarev ◽  
A F Lazarev ◽  
E I Solod ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Surgical Treatment ◽  
Treatment Outcomes ◽  
Bone Fractures ◽  
Term Treatment ◽  
Long Term Treatment ◽  
Osteosynthesis Techniques ◽  
Percutaneous Osteosynthesis

Experience in surgical treatment of 519 patients with bone fractures of different localization been treated during 2000 - 2009 was analyzed. In 335 patients low-invasive percutaneous osteosynthesis with application of original and known low-invasive technologies was performed. In 184 patients with similar fractures osteosynthesis by standard conventional techniques was performed during the period from 2000 to 2004. Comparative analysis of early and long-term treatment outcomes showed the advantage of low-invasive osteosynthesis techniques at treatment of fractures with different localization. Main principles and peculiarities of low-invasive osteosynthesis were determined.

scholarly journals Efficacy Assessment of One-Step Surgical Correction of Scoliotic Spine Deformity Using Cotrel-Dubousset Instrumentation

2004 ◽  
Vol 11 (4) ◽  
pp. 58-67 ◽  
Author(s):  
S T Vetrile ◽  
A A Kisel' ◽  
A A Kuleshov ◽  
S T Vetrile ◽  
A A Kisel' ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Deformity Correction ◽  
Treatment Quality ◽  
Spine Deformity ◽  
Score System ◽  
Scoliotic Deformity ◽  
Spine Mobility ◽  
Efficacy Assessment ◽  
One Step ◽  
Spine Fixation

In 50 patients with dysplastic scoliosis (mobile deformity of III-IV degree) that underwent dorsal correction and spine fixation using Cotrel-Dubousset the mean postoperative correction of primary arch was equal 59.8%. Instrumental correction exceeded natural spine mobility average by 1.5 times. No significant segmental vertebrae derotation after surgical treatment was obtained. Postoperatively correct anatomic correlations of body and disk height on convex and concave deformity sides were restored. In further it was the determinant factor in preserving of achieved correction. The score system for the assessment of surgical scoliotic deformity correction was suggested. It allows presenting complex standardized characteristic of surgical treatment quality.

scholarly journals Surgical treatment of urinary stress incontinence nowadays

Medicina ◽  
2006 ◽  
Vol 43 (8) ◽  
pp. 671
Author(s):  
Sonata Barilienė ◽  
Rosita Aniulienė
Keyword(s):  
Surgical Treatment ◽  
Stress Incontinence ◽  
American Association ◽  
Urinary Stress Incontinence ◽  
Term Treatment ◽  
Suburethral Sling ◽  
First Year ◽  
Surgical Methods ◽  
Long Term Treatment

There are various surgical methods for the treatment of female urinary stress incontinence. According to the opinion of American Association of Urologists, anterior colpoplasty is supposed to be the least effective for the long-term treatment out of four surgical treatment categories (anterior colpoplasty, suburethral sling, colposuspension, and long-needle sling). Nowadays, the open retropubic colposuspension (Burch operation) is considered the most effective and long-term treatment of the female urinary stress incontinence. A first-year postsurgical effectiveness is 85–90% for this operation. Tension-free vaginal tape (suburethral sling) operations are considered as much effective as the above-mentioned surgeries and tend to be very perspective. However, these operations require to be evaluated for their long-term systematic results.

scholarly journals Carbohydrate metabolism and quality of life in patients after surgical treatment of insulinoma

2014 ◽  
Vol 11 (3) ◽  
pp. 18-22
Author(s):  
Ivan Ivanovich Dedov ◽  
Galina Afanas'evna Melnichenko ◽  
Alena Anatol'yevna Krivko ◽  
Nikolay Sergeevich Kuznetsov ◽  
Ekaterina Anatol'evna Troshina
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Carbohydrate Metabolism ◽  
Russian Federation ◽  
Term Treatment ◽  
Psychological Status ◽  
Anthropometric Parameters ◽  
Long Term Treatment ◽  
The Russian Federation

Objectives. T study the quality of life and status of carbohydrate metabolism in patients after surgical treatment insulinoma. Methods: The study involved 20 patients divided in two groups: the first group with a catamnesis duration of up to five years; the second group with a catamnesis duration of more than five years. We studied anthropometric parameters and carbohydrate metabolism as well as psychological questioning of patients using SF-36 questionnaire, the data was considered statistically significant at p0.05. Results. severe combined postoperative complications were more frequent in the first group (63.6% vs. 22.2%, p=0.07), due to extend of the performed surgery. Adrenergic symptoms prior to the surgery were detected in 90.9% of cases in the first group and in 77.7% of cases in the second group. After treatment these numbers decreased to 36.4% and 11.1% respectively (p=0.039 and 0.026). Neuroglycopeniс symptoms before treatment were detected in 90.9% of cases in the first group and for all patients in the second, while after treatment persisted only in 45.5% and 33.3% of cases respectively (p=0.045 and 0.036). Carbohydrate metabolism have normalized for the majority of patients. Two patients (18.2%) of the first group showed impaired glucose tolerance. Improved carbohydrate metabolism was associated with a decrease in body weight in both groups. Results of psychological questionnaires were comparable with the survey data obtained in general population in the Russian Federation. Conclusion. Surgical treatment of insulinomas is highly effective. Physical and psychological status of patients in most cases corresponds with those typical for this age-sex group of the population of the Russian Federation. Long-term treatment results do not depend on duration of the catamnesis. Complications that developed from surgical treatment have the main influence on the health of patients.

scholarly journals Hormonal assessment of patients of reproductive age with uterine myoma for surgical treatment

2019 ◽  
pp. 29-35
Author(s):  
A. V. Kozachenko ◽  
Z. V. Revazova ◽  
L. V. Adamyan ◽  
T. A. Demura ◽  
N. V. Zaytsev
Keyword(s):  
Surgical Treatment ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
Preoperative Assessment ◽  
Term Treatment ◽  
Uterine Bleeding ◽  
Uterine Myoma ◽  
Reproductive Age ◽  
Ulipristal Acetate ◽  
Long Term Treatment

Aim: To assess the efficacy and safety of ulipristal acetate (UA) use in uterine myoma patients before surgical treatment. Material and methods: 78 patients of reproductive age with uterine bleeding and anemia, who underwent laparoscopic myomectomy, were included in the study. Patients were divided into two groups: the first group consisted of 43 women who received 5 mg of ulipristal acetate daily for 3 months before the operation and the second group consisted of 35 patients without ulipristal treatment. A comparative analysis was made between clinical laboratory data groups, pathomorphological changes in myoma and endometrial nodes, and long-term treatment results. Results: As a result of UA therapy uterine bleeding stopped in all patients of the first group, the size of myoma nodes decreased by 25% according to visual diagnostics data, hemoglobin content normalized without iron-containing drugs. Duration of the operation and volume of intraoperative blood loss were less in the first group of patients in comparison with such parameters in the second group. Conclusion: Use of ulipristal acetate for preoperative assessment of patients with uterine myoma of reproductive age suffering from uterine bleeding and anemia is effective and safe.

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